ABSTRACT
Objective To study the value of various MR imaging techniques in the preoperative diagnosis and preoperative assessment of resectability in patients with hilar cholangiocarcinoma.Methods Seventy-eight (patients) with hilar cholangiocarcinoma were diagnosed by imaging of MRI/MRCP/MRA.Based on imaging (analysis) of the extent of local tumor invasion,vascular involvement,hepatic lobar atrophy and distant (metastasis),a preoperative imaging assessment of resectability was done in 78 patients.This preoperative (assessment) was compared with the surgical and pathological findings,so as to evaluate the imaging value in prediction of whether or not resection was feasible in patiens with hilar cholangiocarcinma.Results Of 21 (patients) with unresectable disease according to imaging evaluation, laparotomy was performed in 10 cases,and in all 10cases the tumor was proven not to be resectable at operation.Thus,the surgical and pathological (findings) were in accordance with the result of imaging.Surgical exploration was performed in 57 patients with potentially resectable disease according to imaging evaluation. In this group, the intra-operative diagnosis of the location and nature of tumor was to be in line with the preoperative assessment of imaging, The (diagnosis) accuracy rate was 100%, and 40 patients underwent resection,the resection rate was 70.2%. Of 40 (patients) with resection,29 patients underwent curative resection,the curative resection rate was (50.9)%;11 patients underwent palliative resection.The other 17 patients were found to have (unresectable) disease at laparotomy,including 3 portal venous involvement,5 hepatic arterial (invasion),7 metastatic disease,2 hepatic parenchymal massive involvement. These diseases were not found in pre-operative imaging evaluation.Conclusions MR multi-imaging techniques have high accuracy in the diagnosis of the location and nature of hilar cholangiocarcinoma,and could evaluate accurately the feasibility of resection in patients with hilar cholangiocarcinoma. The main causes of unresectability lie in metastasis of tumor and local vascular involvement.
ABSTRACT
Objective To investigate the reasonable operation timing for patients with acute pancreatitis without obvious infectious manifestation. Methods The findings during the operation and pathological changes in 27 pantients with necrotic pancreatitis were analysed retrospectively.Results Six patients underwent surgical treatment with in 3 weeks. The delimitation between non-necrotic pancreas and necrotic pancreas was not very clear, and the abdominal adhesion and edema were serious. Other 14 cases were subjected to the surgical treatment 3-4 weeks after the onset of illness. The delimitation was clear in 9 cases without obviously infectious signs, but the adhesion of the pancreas bed to the greater omentum or the transverse mesocolon was evident. Various degrees of necrosis was found in 3 cases, and the infection together with pancreatic necrosis developed in the other 2 cases. The rest 7 patients were operated on 5-7 weeks after the disease onset, different degrees of infection and necrosis developed in 3 cases, and local pancreatic abscess formation could be observed.There was a lot of necrosis of fatty tissues on the peri-pancreas and the root of mesentery. Conclusions Clear away of necrotic pancreatic tissue is suitable in 3-4 weeks after the onset of illness in patients with non-infectious necrosis of pancreas.If operation is performed in the initial 3 weeks, intraoperative bleeding may be severe because the detachment between the non-necrotic tissues and necrotic tissues of pancreas was not yet formed completely, which may lead to hard to do the operation and result in increasing intraoperative bleeding and even increasing reoperation .If operation was done after 5 weeks, the infection of the necrotic pancreatic tissues can be seen in most of the cases, and the infection degree in the abdominal cavity may also be serious, which may need more operations to treat.